What is the Medicare Wellness Visit?

  • February 04, 2019

Part of aging well is developing a relationship with a trusted physician. This partnership can allow older adults to feel comfortable sharing health concerns. Small problems can be addressed early before they become big problems. 

In the past, seniors paid for annual wellness visits out of pocket or as part of a large deductible. Passage of the Affordable Care Act (ACA) helped to change this. ACA focuses on both health insurance coverage and improving access to preventative screenings. To that end, the law includes a yearly Wellness visit for all Medicare recipients.

The Wellness visit is different than the Welcome visit that seniors new to Medicare receive.

Understanding the Medicare Wellness Visit

If an older adult has participated in Medicare for at least 12 months, they are entitled to one Wellness visit each year. The visit will usually include a depression screening, vision test, blood-pressure reading, and reflexes test. Most physicians will also use your height and weight to calculate a body mass index.

During the Wellness visit, a primary care physician will also cover:

  • Family history: Having time to discuss an older adult’s family medical history and genetic risks is important. It can help the physician determine what preventative screenings are necessary.
  • Personal history: Some health conditions and behaviors are linked to risk factors for later life illnesses. Smoking and excessive drinking are two examples. Diet, exercise habits, sleep problems, and stress are others. Experiencing a trauma or health event in the past, such as a stroke or cancer, can also play a role in future health issues. When your physician is well versed in your risk factors, they can create a better plan for monitoring your health. 
  • Prevention screenings: Based on your current health status, as well as personal and family medical history, your doctor will create a preventative health-screening schedule. It will likely include mammogram, prostate, colonoscopy, cholesterol, and diabetes screenings. 

The good news is that the Medicare Wellness visit will be paid in full through your Medicare Part B benefit. Follow up screenings, however, might not all be covered. There may also be limitations on how often some testing is conducted. For example, a colonoscopy is covered but only once every ten years unless you are at high risk for colorectal cancer.

If your physician or their billing staff isn’t sure if a screening or test is covered, you can call Medicare directly for an answer at 1(800) 633-4227.

Live Your Healthiest Life at Five Star

At Five Star Senior Living, we are committed to helping older adults live their best quality of life. From our Lifestyle360 enrichment programs to our Signature dining, we focus on nurturing the body, mind, and spirit. 

Call us to schedule a private tour and to learn more about our commitment to health and wellness!

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